護士英語臨床學(xué)習(xí)-急腹癥

Acute Abdominal Pain

急腹癥

Definition

說明　

Causes of acute abdominal pain are varied. Although sometimes called "surgical" abdomen, acute abdominal pain does not always necessitate surgery. Many disorders must be ruled out before a diagnosis is confirmed.

急腹癥的原因很多。雖然它有時也被稱為“手術(shù)”癥，但急腹癥并不是都必須做手術(shù)。有些情況在診斷確認(rèn)前就必須得以排除。

Clinical Manifestations

臨床癥狀

Pain is the most important symptom of acute abdominal pain. A patient may also complain of abdominal tenderness, vomiting, diarrhea, constipation, flatulence, fatigue, and an increase in abdominal girth.

疼痛是急腹癥的最重要癥狀。病人主訴也可以包括腹部壓痛、嘔吐、腹瀉、便秘、氣脹、疲勞及腰圍增大等。

Diagnostic Studies

l Diagnosis begins with a complete health history and physical examination. Physical examination should include both a rectal and a pelvic examination.

l Complete blood count (CBC), urinalysis, abdominal x-ray examination, and an ECG are done initially.

l A pregnancy test should be performed on a woman of childbearing age who has acute abdominal pain.

診斷檢查

首先進行完整的健康史和體格檢查，包括直腸和盆腔檢查。

血尿常規(guī)、腹部X片、心電圖。

育齡期婦女出現(xiàn)急腹癥時應(yīng)行妊娠試驗。

Therapeutic Management

治療

The goal of therapeutic management is to identify and treat the cause. A differential diagnosis needs to be made because many causes of abdominal pain do not require surgery.

In addition to being a therapeutic measure, surgery can be diagnostic. Operative exploration is usually done after careful examination of the patient, and it is justified when "look and see" is better than "wait and see."

治療目的是對病因進行識別和治療。由于很多腹痛病因并不需要手術(shù)，因此，必須進行鑒別診斷。

除了治療外，手術(shù)也可以是一各診斷手段。通常，在對病人作仔細檢查后，也可以作手術(shù)檢查，尤其是在“檢查觀察”比“靜候觀察”更為有利的情況下，手術(shù)檢查無疑更為合理。 醫(yī)學(xué)全在.線提供

Nursing Management

護理

An exploratory laparotomy in which an opening is made through the abdominal wall into the peritoneal cavity is done to detemine the cause of an acute abdomen. If the cause of acute abdomen can be surgically removed (e.g., inflamed appendix) or surgically repaired (e.g., ruptured abdominal aneurysm), then surgery is considered definitive therapy.

剖腹探查就是經(jīng)由腹壁開口觀察腹膜腔，以確定急腹癥的病因。如病因可以通過手術(shù)排除（如闌尾炎)或通過手術(shù)修復(fù)（如腹部動脈瘤破裂)，便可以考慮手術(shù)是最后的治療方法。

Goals

護理目標(biāo)

The patient will have a satisfactory level of pain control, relief of nausea and vomiting, normal bowel sounds within 72 hours, absence of fever, and lungs clear to auscultation.

病人對疼痛控制、惡心嘔吐緩解感到滿意，72小時內(nèi)腸鳴音正常，不發(fā)燒，肺部聽診無雜音。

Nursing Diagnoses

Pain related to surgical incision and inadequate pain control measures

Nausea and vomiting related to decreased GI motility, GI distention, and narcotics醫(yī)學(xué)全在線www.med126.com

Ineffective airway clearance related to effects of anesthesia, sedation, pain, immobility, and location of incision

Constipation related to immobility, pain, medication, and decreased motility

護理診斷

疼痛　與手術(shù)切口和疼痛控制措施不當(dāng)有關(guān)

惡心嘔吐　與胃腸運動減少、胃腸膨脹及麻醉藥品使用有關(guān)

氣道清理無效　與麻醉效果、鎮(zhèn)靜作用、疼痛、活動不能及切口部位有關(guān)

便秘　與活動不能、疼痛、用藥及運動減少有關(guān)

Nursing Interventions

護理措施

1. General care for the patient involves management of fluid and electrolyte imbalances, pain, and anxiety. Preoperative preparation of a patient with an acute abdomen includes a CBC count, typing and crossmatching of blood, and clotting studies. Catheterization, preparation of abdominal skin, and passage of a nasogastric (NG) tube may be done in the emergency department or operating room (OR).

病人一般護理措施包括液體電解質(zhì)紊亂、疼痛和焦慮癥的處理。急腹癥病人術(shù)前準(zhǔn)備包括CBC計數(shù)、血型和交叉配血、凝血化驗。插管、腹部皮膚準(zhǔn)備及鼻胃管可在急診室或手術(shù)室進行。

2. Increased use of laparoscopic procedures has reduced the risk of postoperative complications related to wound care and altered GI motility. These procedures generally result in shorter hospital stays.

腹腔鏡檢查減少了發(fā)生與傷口護理和胃腸道運動減少相關(guān)的術(shù)后并發(fā)癥的危險，可以縮短住院時間。

3. If an NG tube is present, it is connected to suction as ordered. The purpose of this tube is to empty the stomach of secretions and gas to prevent gastric dilatation. The NG tube is checked frequently for patency because it may become obstructed with mucus, sediment, or old blood. An order is usually written to irrigate the tube with 20 to 30 ml of normal saline solution if needed. Repositioning the tube may facilitate drainage. Mouth care and nasal care are essential.

如果使用鼻胃插管，應(yīng)遵醫(yī)囑與抽吸管相連。毛鼻胃插管的目的是排空胃部分泌物和氣體，防止胃擴張。鑒于粘液、渣滓或殘血可能造成堵塞，應(yīng)經(jīng)常檢查鼻胃管是否通暢。護囑中通常寫明，必要時用20至30 ml生理鹽水沖洗插管。重新插管有助于引流，還必須施行口腔護理和鼻部護理。

4. Parenteral fluids are administered to provide the patient with fluids and electrolytes until bowel sounds return. Occasionally, ice chips may be ordered because they relieve a dry mouth.

在腸鳴音恢復(fù)前，非腸道補液可為病人體內(nèi)液體和電解質(zhì)。有時可在護囑中使用冰棒，他們可以起到緩解口干的作用。

5. Although nausea and vomiting are not uncommon after abdominal surgery, these problems are often self-limiting. Observation is important in determining the cause. Antiemetics such as promethazine, prochlorperazine, or trimethobenzamide may be ordered.

盡管腹部手術(shù)后惡心嘔吐并不常見，即使出現(xiàn)也常常是可以自己控制的。重要是要通過觀察確定其原因。也可以開一些止吐藥，如異丙嗪、丙氯拉嗪)或曲美芐胺等。

6. Abdominal distention and gas pains are also common after a laparotomy; they are due to swallowed air and impaired peristalsis resulting from immobility, manipulation of abdominal contents during surgery, and side effects of anesthesia. The resulting pain can be so uncomfortable that medications to stimulate peristalsis, such as bethanechol or neostigmine methylsulfate, may be given. A rectal tube or moist heat on the abdomen may be effective in relieving distention. The physician should be informed of abdominal distention and rigidity. As intestinal activity increases, distention and gas pains gradually decrease.

剖 腹術(shù)后出現(xiàn)腹用及腹痛也是常見的癥狀，這是由吞咽空氣及運動不能引起腸蠕動受損、手術(shù)期間腹內(nèi)容物處理、麻醉副作用等造成的。由此造成的疼痛的會很難受， 可以給些藥物刺激胃腸蠕動，如氨甲酰甲膽堿或甲硫酸新斯的明等。肛管或腹部濕熱敷可有效緩解腹脹。如出現(xiàn)腹脹和腹部強直，就通知醫(yī)生。因為隨著腸動增加， 腹脹和脹痛也會逐漸增加。

7. Emotional support from the nursing staff is important. Honest, clear, concise explanations of all procedures in language the patient and family can understand will assist in allaying anxiety.

護理人員有情感支持也很重要，用病人及親屬能夠理解的語言誠實、清楚、精簡地說明操作程序可以幫助減輕病人的焦慮。

Patient Teaching

病人宣教

1. Patient teaching for discharge begins when the patient returns from the OR. Instructions to the patient and family should include any modifications in activity, care of the incision, diet, and drug therapy.

在病人從手術(shù)室返回時就應(yīng)開始病人出院宣教。病人及親屬指導(dǎo)內(nèi)容包括運動限制、切口護理、飲食和用藥等。

2. Small, frequent meals that are high in calories should be taken initially, with a gradual increase in food intake as tolerated.

開始時可少量多餐，食用一些高卡食物，在許可情況下再逐漸增加攝食量。

3. Normal activities should be resumed gradually with planned rest periods.

應(yīng)逐漸恢復(fù)正常運動，并規(guī)定休息時間。

4. The patient should be aware of possible complications after surgery and should notify the physician immediately if vomitting, pain, weight loss, incisional drainage, or changes in bowel function occur.

病人應(yīng)了解可能的術(shù)后并發(fā)癥，應(yīng)在出現(xiàn)下列情況時應(yīng)立即通知醫(yī)生：嘔吐、疼痛、體重下降、切口滲液或腸道功能發(fā)生變化。